Health Literacy Estimation of English and Spanish Language Caregivers.

BACKGROUND: Provider ability to estimate caregiver health literacy (HL) in English-speaking caregivers has been shown to be poor, but estimation of HL in Spanish-speaking caregivers by physicians and staff has yet to be studied. Linguistic differences can further hinder communication in medical care. OBJECTIVE: This study evaluated how well pediatric providers and staff predict caregiver HL as measured by two HL tools in a bilingual (English/Spanish) population. METHOD: For this study, we obtained a convenience sample of caregivers, evaluating one group with the Newest Vital Sign (NVS) and the second group with the Short Assessment of Health Literacy (SAHL). Physicians/nurse practitioners (NPs), and medical assistants (MAs) estimated caregiver scores for each tool. We dichotomized estimated and actual scores for each tool using published standards. We used McNemar's test and Cohen's Kappa to evaluate agreement between dichotomized predicted and actual scores. We used log binomial regression to examine how caregiver's language affected agreement between dichotomized caregiver scores and provider estimates. All physicians/NPs were native English speakers only and all MAs were native bilingual English/Spanish speakers. Physicians/NPs used interpretation services when appropriate. KEY RESULTS: Fifty caregivers were evaluated using the NVS and 50 using the SAHL. There was no overall association between dichotomized physician/NP or MA estimation and caregiver score for either tool. However, providers' estimates were less likely to match caregiver scores when the caregiver's language was Spanish (NVS: relative risk [RR] = 0.57 [95% CI 0.37, 0.87], SAHL: RR = 0.37 [95% CI 0.23,0.6]). CONCLUSION: Physician/NP and MA ability to estimate caregiver HL in English proficient and limited English proficiency caregivers is poor. The physician/NP group was less likely to estimate HL correctly if the caregivers spoke Spanish. Providers must use additional caution when providing cross-language care. [HLRP: Health Literacy Research and Practice. 2018;2(2):e107-e114.]. PLAIN LANGUAGE SUMMARY: This study examined estimation of health literacy of English- and Spanish-speaking caregivers by pediatric providers and medical assistants. We found that both providers and staff estimate caregiver health literacy poorly, and that primary language discordance may be a factor. The results support the institution of universal health literacy precautions for all caregivers of pediatric patients.

Postpartum depression screening in the Neonatal Intensive Care Unit: program development, implementation, and lessons learned.

OBJECTIVE: The aims of this project were to describe the development of a postpartum depression screening program for mothers of infants in the Neonatal Intensive Care Unit and assess the implementation of the screening program. METHODS: Screening began at 14 days postpartum and was implemented as part of routine medical care. A nurse coordinator facilitated communication with mothers for increasing screen completion, review of critical self-harm items, and making mental health referrals. During the 18-month study period, 385 out of 793 eligible mothers completed the screen. RESULTS: Approximately 36% of mothers had a positive screen that resulted in a mental health referral and an additional 30% of mothers had screening results indicating significant symptoms. CONCLUSION: Several barriers were identified, leading to adjustments in the screening process, and ultimately recommendations for future screening programs and research. Development of a postpartum depression screening process in the Neonatal Intensive Care Unit involves support, training, implementation, and coordination from administrators, medical staff, new mothers, and mental health specialists. Several predictable challenges to program development require ongoing assessment and response to these challenges. RELEVANCE: This study highlights the expanding role of the psychologist and behavioral health providers in health care to intervene as early as possible in the life of a child and family with medical complications through multidisciplinary program development and implementation, as well as key considerations for institutions initiating such a program.

Postpartum depression in the NICU: an examination of the factor structure of the Postpartum Depression Screening Scale.

PURPOSE: The purpose of this research was to examine the construct validity of scores from the Postpartum Depression Screening Scale administered to mothers of infants in a neonatal intensive care unit. SUBJECTS: Two samples (n = 385 and n = 110) of mothers with infants in a neonatal intensive care unit in the south-central region of the United States completed the Postpartum Depression Screening Scale 2 weeks postpartum. Both samples were similar in race and education level but differed according to marital status. DESIGN: Study 1 was retrospective and descriptive, whereas study 2 was prospective and descriptive. METHODS: In study 1, confirmatory factor analysis was used to evaluate the originally proposed 7-factor structure and a 1-factor model. Because of overly high correlations between 3 of the factors, a revised 5-factor model was also tested. In study 2, confirmatory factor analysis was again used to test the construct validity or goodness of fit of the 7-factor and 5-factor models. MAIN OUTCOME MEASURES: Goodness-of-fit indices and factor pattern coefficients. PRINCIPAL RESULTS: In study 1, high correlations between 3 of the factors in the 7-factor model did not converge. Thus, a 5-factor model was also tested. This model had reasonable fit: χ= 1339.70 (550); P < 0.01; comparative fit index = 0.85; root mean square error of approximation = 0.06; and 90% confidence interval for root mean square error of approximation = 0.058 to 0.067. In study 2, confirmatory factor analysis was again used to test the construct validity or goodness of fit of the 7-factor and 5-factor models. Results for the 7-factor model indicated unacceptable fit: χ (539) = 959.10; P < 0.01; comparative fit index = 0.76; and root mean square error of approximation = 0.09. The 5-factor model was also poor: χ (550) = 992.95; P < 0.01; comparative fit index = 0.75; and root mean square error of approximation = 0.09. CONCLUSIONS: Although the construct validity of the 7-factor model of the PDSS was not supported for this sample of mothers, additional factor analytic work was used to develop and provide initial validation of a 5-factor model. Future research should continue to explore the unique experiences of mothers in the NICU who experience postpartum depression.

Pediatric behavioral health screening in primary care: a preliminary analysis of the pediatric symptom checklist-17 with functional impairment items.

BACKGROUND: Roughly 21% of youth in the United States meet criteria for a mental health diagnosis, but only one-fifth of those children obtain help. The Pediatric Behavioral Health Screen (PBHS) utilizes the Pediatric Symptom Checklist-17 (PSC-17) and functional impairment items to assess behavioral health concerns. METHODS: Data were obtained from a systematic chart review for children 6 to 16 years old. Descriptive analyses and a confirmatory factor analysis were used to evaluate the clinical performance and utility of the PBHS. RESULTS: A positive screen was endorsed for 26.7% of the sample, of whom 68% also experienced functional impairment. Clinicians appropriately administered the screen 73.5% of the time. The 3-factor model of the PSC-17 exhibited a good model fit. CONCLUSIONS: Prevalence rates of psychosocial concerns and functional impairment affirm the need for routine behavioral health screening in the pediatric primary care setting. The PBHS exhibited good psychometric performance and clinical utility.

Reliability of the postpartum depression screening scale in the neonatal intensive care unit.

BACKGROUND: Rates of postpartum depression have been found to be significantly higher in mothers of infants in the neonatal intensive care unit (NICU) than the general population estimate of 10%-15%, making routine screening for these mothers essential. OBJECTIVES: The aim of this study was to examine the reliability (internal consistency) and construct validity of the Postpartum Depression Screening Scale with a sample of mothers of infants in the NICU. METHODS: A total of 111 (40% of eligible) mothers participated in the study. Mothers completed a brief demographic questionnaire and the screening scale at 14 or greater days postpartum. Estimates of internal consistency were evaluated using Cronbach's coefficient alpha. RESULTS: On the basis of the scale total score, 52% of mothers had a positive screen and an additional 30% received a score indicating that they were at-risk. Reliability estimates were consistent with previous research and indicate excellent internal consistency for the total score and adequate to good internal reliability for subscales scores. The coefficient alpha for total score equaled .95, and alpha for subscale scores ranged from .72 (Anxiety/Insecurity) to .89 (Suicidal Thoughts). Interscale correlations were consistently lower than subscale reliability estimates (coefficient alpha) and were lower than subscale-to-total score correlations, suggesting initial support for the proposed structure of the scale for mothers in the NICU. DISCUSSION: Most of this sample of mothers experienced significant symptoms of postpartum depression. The Postpartum Depression Screening Scale is a promising tool for screening mothers with infants in the NICU. Additional research is necessary to better understand the construct and predictive validity of scores among these mothers. Current and future research will contribute to the routine use of scale as a screening tool in this environment.

Psychological adjustment of family caregivers of children who have severe neurodisabilities that require chronic respiratory management.

Although much is known about the risks to health and well-being that occur among family caregivers of children with disability, little is known about the unique group of caregivers of children with severe neurodisabilities who require varying degrees of respiratory care including ventilator support. This present study examined the psychological adjustment of caregivers in these situations, and tested the prediction that caregiver coping and problem-solving styles would be predictive of their physical and emotional health. Hierarchical regression analyses revealed that demographic characteristics and the severity of pulmonary condition were unrelated to caregiver adjustment. A coping style characterized by developing relationships, pursuing activities that promote self-worth and individuality, and a lower negative orientation toward solving problems were significantly predictive of caregiver distress. These data indicate that caregiver adjustment in these situations is influenced by cognitive-behavioral characteristics that could be addressed in educational and therapeutic programs provided in the clinic and in the community.